tbuckley/cabot-search huggingface dataset:
Abstract 13000: The Effect of Flow Dynamics on the Neotissue Formation of 3D Printed Tissue Engineered Vascular Graft
Authors: Hidenori Hayashi, Hiroshi Matsushita, Tatsuya Watanabe, Nora Lee, Tyler Dunn, Katherine Nurminsky, Paige Mass, Vincent Cleveland, Jacqueline Contento, Kevin Nelson, Joey Huddle, Daniel Rodgers, Keigo Kawaji, Jed Johnson, Laura Olivieri, Axel Krieger, Narutoshi Hibino
Journal: Circulation (2022)

Introduction: Complex vascular reconstruction such as that of the right ventricle to pulmonary artery (RVPA) and the aortic arch remains challenging due to the various 3D geometry of each patient. Tissue-engineered vascular grafts (TEVG) possess not only excellent antithrombotic and anti-infective properties but also the ability to grow as the patient matures. 3D printed patient-specific TEVG can maintain optimal hemodynamics with the growth of the patient and may improve surgical outcomes. We applied our unique 3D printing technology to create patient-specific TEVG for RVPA and the aortic arch. Methods: We acquired MRI and 4-dimensional flow data for the native anatomy of pigs (n=8) to design a patient-specific TEVG of the pulmonary artery (n=5) and the aortic arch (n=3) 4 weeks prior to surgery. The optimal shape of the branched vascular graft (n=8) was designed using a computer-aided design informed by computational flow dynamics analysis. We manufactured and implanted the grafts into the RVPA or aortic arch in the porcine model. The grafts were explanted after surgery at 8 - 12 weeks for evaluation. Pre- and post-op implant flow dynamics data in MRI and histology were analyzed. Results: The local neointimal thickness of TEVG in histology and the corresponding area of wall shear stress in 4D MRI were measured. Low wall shear stress, an aspect of MRI flow analysis, demonstrated a significant correlation with decreased neointimal thickness through histology (R2=0.65, P=0.016), which suggested optimal shape and design is important for appropriate neotissue formation. Conclusions: Our 3D printed custom designed TEVG demonstrated optimal anatomical fit maintaining ideal flow dynamics can attenuate neointimal hyperplasia and appropriate neovessel formation.
Abstract 14127: The Role of Sodium Glucose Co-Transporter 1 in Hyperglycemia Ischemia Reperfusion Injury
Authors: Alhanoof Almalki, Sapna Arjun, Hussain Jasem, Derek M Yellon, Robert Bell
Journal: Circulation (2022)

Introduction: Hyperglycemia is a common finding in ACS patients in both diabetic and non-diabetic, it is considered a powerful predictor of prognosis and mortality. The role of hyperglycemia in ischemia-reperfusion injury is not fully understood, whether the Sodium Glucose Co-Transporter 1(SGLT1) plays a role in increase injury, before and/or after reperfusion, remains to be elucidated. SGLT2 inhibitors clinical trials have shown significant improvements in cardiovascular outcomes in diabetic and non-diabetic, yet the mechanism is not fully understood and whether SGLT1 plays a role in infarct augmentation remains to be elucidated. Hypothesis: High glucose at reperfusion leads to excess myocardial injury and the increased injury is mediated through the activity of SGLT1. Methods: RT-PCR and in-situ hybridization (RNAScope) combined with Immunofluorescence integrated co detection with different cell marker techniques were used to detect SGLT1 mRNA expression in Sprague-Dawley whole myocardium and Zucker diabetic rats. An Ex-vivo Langendorff ischemia-reperfusion perfusion model was used to study the effect of high glucose on myocardium at reperfusion. Canagliflozin a non-selective SGLT inhibitor (1μmoL/L to block the SGLT1 and SGLT2 transporter and 5nmol/L to block only the SGLT2 transposer) and Mizagliflozin a selective SGLT1 inhibitor (100nmol/L) was introduced following ischemia at two different glucose concentration concentrations at reperfusion and its effect on infarct size measured using triphenyltetrazolium chloride (TTC) staining. Results: Our data reveal that SGLT1 is homogenously expressed throughout the myocardium and is particularly evident within the vasculature. We have also demonstrated that high-glucose mediated injury in the isolated, perfused heart model and it is abrogated through the administration of both mixed SGLT2/SGLT1 inhibitor, canagliflozin, at a dose that inhibits both SGLT2 and SGLT1, and through the administration of novel specific SGLT1 inhibitor, Mizagliflozin. Conclusions: We have shown that SGLT1 is present in the myocardium. Hyperglycemia appears to augment myocardial infarction and inhibition of SGLT1 attenuates this increase.
Abstract 12866: Risk Factors For Major Adverse Cardiovascular Events Post-Acute Coronary Syndrome Hospitalization in Patients With Myeloproliferative Neoplasms
Authors: Orly Leiva, Andrew Jenkins, Rachel Rosovsky, Rebecca Karp-Leaf, Katayoon Goodarzi, Gabriela Hobbs
Journal: Circulation (2022)

Introduction: Myeloproliferative neoplasms (MPNs) are clonal stem cell neoplasms associated with increased thrombotic risk. However, long-term outcomes after acute coronary syndrome (ACS) and identification of MPN-specific risk factors have not been characterized. Methods: Single-center, retrospective cohort of patients with MPN admitted for ACS from 2000 to 2020 (n = 41). Primary outcomes were major adverse cardiac events (MACE) and bleeding. MACE was composite of cardiovascular (CV) death, myocardial infarction, ischemic stroke, and heart failure (HF) hospitalization. Patients with and without MACE and bleeding were compared to identify risk factors; univariable and multivariable Cox proportional hazards and competing-risk regression models were used. Results: Patient characteristics described in Table 1. After a median follow-up of 80 months, 28 patients had MACE and 14 experienced bleeding. Patients with MACE had shorter median time to index ACS event (35 mos vs 76) and higher rates of JAK2 mutation (82% vs 54%), history of HF (46% vs 15%), and median white blood cell count (WBC, 13 vs 8) at index event compared with patients without MACE. Patients with bleeding had higher rates of JAK2 mutation (93% vs 63%) and WBC (17 vs 10), and lower hydroxyurea use (50% vs 85%) compared with patients without bleeding. Cox and competing-risk regression results in Table 2. Conclusions: Patients with MPN and ACS are at high risk of MACE and bleeding. JAK2 mutation and elevated WBC count (≥ 20 K/μL) at time of index ACS were associated with MACE and bleeding. ACS event occurring within 12 months of MPN diagnosis was associated with MACE. Larger studies are needed to confirm our results.
Abstract 12738: Tracking Fluoroscopic Time Amongst Cardiology Trainees
Authors: William Leon, Benjamin Stripe
Journal: Circulation (2022)

Introduction: ACC and ESC guidelines for cardiologists in training recommend 200-300 coronary angiographies as primary operator before completion of training. There are different ways to measure an operator's proficiency of performing a coronary angiogram including contrast volume, fluoroscopy time, and total time of procedure. Data from previous studies has shown that fluoroscopy time is the best measure of trainee progression. Fluoroscopy time is significantly longer in trainees who have performed less than 100 interventions. Objectives: Utilize fluoroscopy time during cardiac catheterization to help direct safety in cardiology trainees. Methods: Cardiac catheterization operator data from UCD cardiology fellows between 2014 - 2017. Data was categorized into 3 categories: left heart catheterizations (LHC) , right heart catheterization (RHC), and left and right catheterization combination (LHC + RHC). Data was excluded if the operator performed any other procedure in addition to catheterization. Data was analyzed using a One-way ANOVA analysis. Results: A total of 853 cardiac catheterizations performed by trainees. LHC fluoroscopic time declined from year 1 (9.64 mins) to year 2 (7.62 mins, p: 0.009) (figure 1). LHC + RHC fluoroscopic time declined from year 1 (12.89 mins) to year 2 (10.77 mins, p: 0.007). There was no statically significant change in fluoroscopic time in operators over their three years of training who performed RHC. Operators in their third year of training did not have any statistically significant improvement in their fluoroscopic time when compared to their second year of training. Conclusions: Fluoroscopic time decreases after first year of training in LHC and LHC + RHC cases. There is no significant change in fluoroscopic time amongst fellows who perform RHC regardless of years of experience. Safety efforts to minimize fluoroscopic time should be focused on fellows in their first year of training
Abstract 14008: Socioeconomic Status and Prediction of Incident Heart Failure in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Lena M Mathews, Sui Zhang, Ruth-Alma Turkson-Ocran, Amira Collison, Deidra Crews, Gerardo M HEISS, B Gwen Windham, Patricia Chang, Josef Coresh, Kuni Matsushita, Chiadi E Ndumele
Journal: Circulation (2022)

Introduction: Socioeconomic status (SES) is a potent risk factor for heart failure (HF), but current HF prediction models do not incorporate data on SES. It is not known if the performance of HF risk prediction algorithms differs by SES, and how including SES in risk models impacts risk prediction. Methods: We performed an analysis of participants without HF at Visit 1 (1987-89) of the ARIC study. SES was assessed by household income, educational attainment, Area Deprivation Index, and as a combined cumulative SES score that included all three measures. Incident hospitalizations and deaths related to HF were assessed through 12/31/2019. We compared risk discrimination (c-statistic) of the established ARIC HF risk score across SES categories, and assessed calibration within SES strata by comparing observed versus predicted risk. We examined changes in risk discrimination, net reclassification and calibration (calculating the Hosmer-Lemeshow statistic for the latter) with adding SES to the ARIC HF risk score. Results: We studied 14,468 individuals; 54% were women, 26% were Black adults and 22% had low cumulative SES. There were 3,568 HF events over 33 years of follow-up. The c-statistic of the ARIC HF risk score was lower in those with low versus high cumulative SES (0.726 vs 0.765). There were differences in the ARIC HF risk score’s calibration by SES, with lower predicted than observed HF risk in those with low SES in all quintiles of predicted risk (Figure). Calibration improved with adding SES to the risk model (change in Hosmer-Lemeshow 127.6 to 98.3), especially in those with low SES (Figure). Adding SES to the model modestly improved risk discrimination (change in c-statistic 0.767 to 0.771; p&lt;0.001) and changed net reclassification (0.05 [95% CI 0.02-0.08]). Conclusions: HF prediction algorithms underestimate HF risk in those with low SES. Systematic assessment and incorporation of SES data may enhance HF risk prediction in socioeconomically diverse populations.
Abstract 13645: Transcutaneous Vagus Nerve Stimulation Restores the Cardiac Phenotype in Heart Failure With Preserved Ejection Fraction by Modulating the Immune Cell Profile
Authors: Kassem Farhat, Monika Niewiadomska, Lynsie Morris, Sarah Bland, Seabrook Whyte, Rylee Barber, Karlie Sample, Kurt A Zimmerman, Stavros Stavrakis
Journal: Circulation (2022)

Introduction: A proinflammatory state plays a central role in heart failure with preserved ejection fraction (HFpEF) but the role of specific immune cells remains unclear. Transcutaneous vagus nerve stimulation (tVNS) modulates immune responses via the cholinergic anti-inflammatory pathway, which involves acetylcholine-dependent activation of α7 nicotinic acetylcholine receptors (α7nAchR) on macrophages. Hypothesis: tVNS reverses the HFpEF phenotype by reducing resident macrophage number and pro-inflammatory cytokine production in an acetylcholine-α7nAchR-dependent manner. Methods: We induced HFpEF in male C57BL/6 CCR2-RFP mice with nitric oxide synthase blocker (L-NAME) and a high-fat diet for 5 weeks. C57BL/6 CCR2-RFP mice fed with standard chow diet served as controls (n=7). We randomized the mice to sham, or tVNS with or without the α7nAchR inhibitor methyllycaconitine (MLA) (n=6 in each group) for 4 weeks, followed by euthanasia. Cardiac macrophages were analyzed using flow cytometry. Resident macrophages were further subdivided based on MHC2 and CCR2 expression. Results: HFpEF mice exposed to sham developed hypertension, diastolic dysfunction, increased heart weight normalized to tibia length, and left ventricular fibrosis compared to the control mice, while tVNS restored these parameters towards the control values. MLA partially reversed the protective effect of tVNS in these parameters. Flow cytometry data revealed a significant increase in resident macrophages in HFpEF sham compared to control hearts, mainly driven by the MHC-/CCR2- subtype (F). Notably, tVNS restored the numbers of resident macrophages to the control levels, while MLA partially attenuated this effect (Figure). Conclusions: tVNS improves the cardiac phenotype in HFpEF mice by modulating cardiac resident macrophages, in an acetylcholine-α7nAchR-dependent manner.
Abstract 13195: A Case of Ebstein Anomaly Diagnosed Following Tricuspid and Pulmonic Valve Infective Endocarditis in an Adult Patient
Authors: George E Tsourdinis, Kifah Hussain, Iva Minga, Jason C Robin, Amit Pursnani
Journal: Circulation (2022)

Background: We present a rare case of infective endocarditis (IE) involving both tricuspid (TV) and pulmonic valves (PV) in the setting of newly diagnosed Ebstein anomaly (EA) with isolated, small membranous VSD. Case: A 48 yo woman with no known medical history presented with two weeks of fever, flu-like symptoms, and dyspnea. Vitals showed fever, tachycardia, and tachypnea. Poor dentition, grade III systolic murmur, and S3 gallop were noted on physical exam. EKG showed sinus tachycardia and right bundle branch block. Laboratory studies showed leukocytosis and elevated CRP. A chest CT revealed bilateral lung infiltrates in a rounded configuration concerning for septic emboli. Blood cultures grew Streptococcus mitis , and IV antibiotics were initiated. TTE revealed 3.2cm apical displacement of the TV resulting in right ventricular atrialization, diagnostic for EA. TTE also found a 26x17mm vegetation on the septal and anterior leaflets of the TV with moderate tricuspid regurgitation and an 11x6mm vegetation on the PV, confirmed by TEE. Cardiac MRI also noted a focal aneurysm of the membranous interventricular septum with a hemodynamically insignificant shunt. Discussion: While interatrial communications are seen in a majority of EA patients (80-94% of cases), this patient presented solely with a small membranous VSD and absence of ASD and PFO. Moreover, this patient had no PDA to depend on for pulmonary flow. Remarkably, she had an asymptomatic course with EA until the development of endocarditis. It is believed the presence of an isolated VSD in this patient’s severe EA likely promoted forward pulmonic flow in an already inadequate right ventricle. Right-sided IE is itself rare (5-10% of cases) with isolated PV involvement being even rarer (2% of cases). This patient’s uncorrected EA with redundant TV and PV leaflet tissue likely contributed as a nidus for simultaneous infection of both valves.
Abstract 14073: Hypercalcemia Induced Reversible LBBB
Authors: Parvathy Ravi Sankar, Venu Menon
Journal: Circulation (2022)

Background: Parathyroid hormone (PTH) and calcitriol are the two hormones responsible for calcium and phosphate homeostasis. PTH exerts its effect on the renal tubular calcium reabsorption and bone resorption. PTH secretion is modulated by calcium acting on the sensitive calcium-sensing receptor on the parathyroid cells. Primary hyperparathyroidism has been linked to hypertension and valvular calcification. Structural changes are also seen including elevated left ventricular mass, diastolic dysfunction and myocardial calcification. Case presentation: A 61-year old female with hyperlipidemia and osteoporosis presented with polyarticular joint pain and diffuse myalgia noted to have elevated PTH of 90 pg/ml and elevated Ca of 10.1 mg/dl. Her calcium levels has ranged from 10.1 to 11.2 mg/dl and her PTH ranged from 90 to 113 pg/ml. She had a negative sestamibi scan, and thyroid ultrasound showed fusiform&amp;nbsp;lesion measuring&amp;nbsp;0.82 x 0.36 in the right posterior neck&amp;nbsp;suspicious for a parathyroid adenoma with the plan made for resection. The diagnosis at this time was primary hyperparathyroidism induced hypercalcemia. She developed exertional dizziness and was found to have a new LBBB and reduced ejection fraction of 40-45% with a small fixed defect in the septal area which was attributed to the LBBB. She was initiated on metoprolol succinate 25 mg, irbesartan 75 mg, atorvastatin 40 mg and aspirin 81 mg because of the reduced systolic function. SPECT was negative for ischemia with a fixed decreased uptake of the septum. She underwent right lower parathyroid excision on 11/2021 with normalization of calcium to 9.4 mg/dl and PTH to 9 pg/ml with resolution of the LBBB and systolic function in 2/2021 improving to 48%. Discussion: Calcium plays a key role in cardiac excitation, depolarization, repolarization, and also coupling of these signals to mechanical contraction via calcium induced calcium release and myofibril cross linking. In this case, calcium was only mildly elevated to cause a partial conduction defect. Literature is lacking on whether there is a threshold level for calcium that predisposes to varying degrees of conduction disease. This case also highlights the temporal nature of symptom resolution following parathyroid surgery with resolution of the LBBB.
Abstract 13629: Unique Age- and Sex-Specific Patterns Identified for Prodromal Symptoms of Sudden Cardiac Arrest
Authors: Bernadine Dizon, Kyndaron Reinier, Harpriya Chugh, Madison Seifer, Ziana Bhanji, Tristan Grogan, David Elashoff, Chad Sorenson, Arayik S Sargsyan, Audrey Uy-Evanado, Faye L Norby, Angelo Salvucci, Jonathan Jui, Sumeet S Chugh
Journal: Circulation (2022)

Introduction: The majority of individuals who suffer sudden cardiac arrest (SCA) display prodromal symptoms in the preceding hours, days and weeks. These could potentially improve risk assessment for SCA, making it important to explore the influence of age and sex on symptom manifestation. Hypothesis: Prodromal symptoms of SCA are different based on age and sex. Methods: We included cases of witnessed SCA (ages 35-85) attended by emergency medical services following 911 calls made in Ventura County, CA (2015-2021). SCA was defined as a sudden, unexpected pulseless condition of likely cardiac origin; non-cardiac etiology were excluded. All cases were required to have at least one inclusion symptom recorded in the EMS narrative at the time of the 911 call. These were acute coronary syndrome (ACS) or SCA symptoms reported in the published literature. We constructed mutually exclusive symptom groups in hierarchical order: chest pain, dyspnea, syncope/palpitations, and other. We compared symptoms in middle age (35-64y) and older (65-85y) cases using chi-square tests. Results: Of 404 SCA cases that met analysis criteria, 122 (30%) were female. Women comprised 22% of the middle-age group and 37% of the older group. In the middle-age group, chest pain was the most common symptom among men (48%) but was half as common in women (24%, p&lt;0.01, Figure). Among middle-aged women, dyspnea was the most common symptom (39%) and significantly higher compared to men (22%, p &lt;0.05). Chest pain prevalence was lower in both sexes in the older group (31% in men vs 20% in women). We observed no significant differences in dyspnea by sex in the older group, nor differences in syncope/palpitations or other symptoms in either group by sex. Conclusions: We observed unique pre-SCA prodromal symptom patterns after stratifying by age and sex, most notable in middle age. These findings suggest the importance of considering age and sex while developing SCA prediction algorithms that include prodromal symptoms.
Abstract 13039: A Rare Case of Anomalous Aortic Origin of Right Coronary Artery From Left Coronary Cusp Presenting With Recurrent Atypical Chest Pain
Authors: Pramukh Arun Kumar, Mahati Dasari, Sushmita Prabhu, Anoop Titus, Boskey Patel, Michelle hadley
Journal: Circulation (2022)

Background: The incidence of anomalous aortic origin of the right coronary artery (AAORCA) is between 0.026% and 0.25%. There is limited data regarding medical versus surgical management. We present a case of AAORCA which did not “qualify” for surgical intervention but remained symptomatic on medical management. Presentation: A 58-year-old female with paroxysmal atrial fibrillation presented for the eighth time in the past two years with recurrent atypical chest pain and lightheadedness. Vital signs and cardiac biomarkers were normal. Work-up: EKG showed normal sinus rhythm. TTE revealed EF 68%. Myocardial perfusion imaging was normal but exercise stress test showed ventricular ectopy, ventricular bigeminy, short bursts of ventricular tachycardia (VT) at peak exercise, and a 7-beat run of VT. A 30-day event monitor revealed a 17-beat run of VT at a rate of 173 bpm (Figure A). Management: Cardiac catheterization showed the dominant right coronary artery (RCA) arising from the left coronary cusp with a shared ostium to the left coronary system (Figure B-D). A coronary CT scan confirmed dominant RCA arising from left coronary cusp (Figure E) with an interarterial course (Figure F) and slit-like appearance of the proximal RCA, with a likely intramural course (Figure G).She was managed conservatively with restriction of vigorous exercise, up-titration of beta-blockers, addition of anti-anginal agents and implantation of loop recorder. Conclusion: The most updated consensus statement for AAORCA recommends surgical intervention for those with signs or symptoms of myocardial ischemia (true angina, findings on provocative testing, aborted sudden cardiac arrest or non-vagally-mediated arrhythmia).Although our patient did not “qualify” for surgical intervention, she continued to experience refractory symptoms. Hence, it is of utmost importance to consider surgical intervention in patients who have failed medical management, for improved quality of life.